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There’s a lot going on the mind of a mother-to-be when she is about to have a C-section. It is major surgery – you will have a baby at the end of it. You may have concerns about anaesthesia – what type the doctor might use and how it will all pan out. You may have heard from other mothers about an epidural, but a spinal block is more commonly used during a C-section. Continue reading for everything you need to know about spinal anaesthesia.
What is a Spinal Block?
A spinal block is a type of regional anaesthetic that is injected directly into the cerebrospinal fluid that bathes the nerves and spinal cord. A spinal block is different from a spinal epidural. The spinal block is an injection of anaesthetic directly into the spinal fluid which quickly and effectively blocks the pain for a few hours. You feel numb from the abdomen down, but it allows the use of your arms, head and upper body.
In contrast, an epidural uses a larger needle that goes into your epidural space and not into the membrane that covers your spinal cord. A catheter is then used to administer the anaesthetic for a long time continually, and it can be made to last longer than a spinal. Spinal block is given if you decide that you need pain relief late in labour or there is not enough time for an epidural and the delivery is likely to be very soon. It is also the preferred spinal injection for a c-section if you do not already have an epidural in place.
How is Spinal Anaesthesia Given?
The painkilling drugs are injected into the spinal fluid surrounding the nerves and the spinal cord. To do that, the anaesthesiologist uses a very fine needle to penetrate the dura, the tissue which encapsulates the spinal cord and the spinal fluid. The spinal is a single injection of anaesthetic in the spinal area and is a one-shot deal; therefore, there is only one chance to deliver the drugs. It’s also noteworthy that there is almost no chance of mistakenly piercing your spinal cord as the needle goes inside below where the spinal cord ends.
The way this is performed is quite simple. The anaesthesiologist will come in and ask you to sit on the side of the bed or lie on your side. Your back is then cleaned with iodine solution, and a sticky, plastic guard type-contact paper is placed on your back. A topical anaesthetic is first used, and then the drugs are injected into the spinal fluid with a fine needle. It leaves you numb, but ambulatory. However, you won’t be able to walk for a while.
How Does a Spinal Work?
The spinal block works quickly and very effectively to deliver pain relief to your lower body down from the abdomen for a limited period. During this time you are alert and know everything that is happening except the sensations in your lower body. You will be able to move your arms, upper body and head as well. The anaesthetic is injected using a fine needle which is carefully guided into the membrane surrounding the spinal cord through your lower back. Since they spread more easily in the spinal fluid, only a small dose of anaesthetic is required in this case, and it works by blocking the pain signals going from the uterus and lower body to the brain. This will also stop you from feeling your contractions, and your abdomen will feel numb in about 10 minutes.
Who Should Avoid Taking a Spinal?
Not all women are given spinal for pain relief. It is avoided if they have abnormally low levels of blood pressure because of problems such as bleeding, blood infections, previous allergic reaction to local anaesthetics or a skin infection in the lower back where the needle enters. It is also not given to women who are on some specific blood-thinning medications.
What Are the Benefits of Having Spinal Anaesthesia for C-section?
- Spinal anaesthesia avoids the need for a general anaesthetic to be administered during the procedure. This means you will be fully awake and can participate in the birth of your baby along with your partner in the operating theatre.
- You will have almost complete pain relief and be alert during the procedure. You are also less likely to feel sick unlike under a general anaesthetic.
- Once your baby is born, you can hold him right away and start feeding him. The baby will also be more alert if you are not under a general anaesthetic.
- Unlike an epidural where a tube is left stuck to the back, spinal is given as a single injection for pain relief.
- It is much faster than an epidural and gives rapid pain relief that kicks in within five to ten minutes.
- The catheter inserted into your bladder is likely to be for a shorter period compared to an epidural.
What Are the Side Effects of Spinal Block?
- Depending on the drugs administered, you may or may not be able to maintain sufficient muscle strength, which means you may not be able to move around, even with assistance. Either way, obstetric caregivers will recommend you to stay in bed after you’ve had a spinal block. You will also need an IV and constant fetal monitoring.
- The administered drugs may temporarily reduce your blood pressure. This can reduce blood flow to the baby, which in turn slows down its heart rate. Therefore, continuous fetal monitoring is needed.
- If opioids are used, especially ones such as fentanyl, it can cause itchiness around the nose and lips. Some women also get nauseous and throw up during labour.
- In some cases, it can cause mild respiratory and circulatory depression. When the drugs used in the anaesthesia travels higher than intended within the spinal fluid, a high spinal block or high neural blockade can occur. This is more common in women who are short, obese or sensitive in general to anaesthesia. The anaesthesia can cause mild shortness of breath and numbness or weakness in the upper body such as shoulders, arms and trunk. This is followed by nausea with or without vomiting. At first, the high spinal block can seem frightening, but it’s not life-threatening. It can be treated with intravenous drugs that stabilise the heart rate and blood pressure and supplemental oxygen.
- To administer anaesthesia, your spinal cord’s protective membrane is purposefully punctured. This can cause some of the spinal fluid to leak, giving rise to headaches. While they are not serious, they can be troublesome. Women often describe throbbing and episodic pain around the forehead, or behind the eyes or at the base of the head extending down to the spine. Most of them resolve within a few hours, and only about 1 in 500 women report severe headaches.
- Backaches are also reported as a result of trauma due to the needle piercing layers of fat, muscle and ligaments. The pain is usually reported to be dull and mild soreness, and they resolve within a few weeks.
Below are some FAQs about spinal anaesthesia for C-section.
1. Spinal Block for C-section – Does it Hurt?
The procedure of getting a spinal block is generally quick and painless, but you may feel a stinging sensation when the drugs are first injected into the site. If you feel pins or needles in your legs during the injection, immediately tell your anaesthetist about it. It may be a sign of temporary nerve damage, and the needle needs to be re-positioned. Temporary nerve damage is rare and repairs itself in a few months. Only about one in 1000 to 2000 women are affected by this.
2. General Anesthesia Vs Spinal Anesthesia for C-section?
General anaesthesia leads to a total loss of sensation and consciousness. This means you are not awake and won’t have reflexes. It is given under emergency conditions or when the regional anaesthetic doesn’t work.
3. Spinal or Epidural for C Section?
Both of these are a regional anaesthetic. The difference between spinal and epidural for c-section lies in the duration of numbing and their effectiveness. While spinal blocks are given in one shot and have a high quality of pain blocking for a shorter period, epidurals last longer and are not as potent at blocking the pain. Spinal block is often used as C-sections are generally not a long procedure; therefore, a continuous drip of anaesthesia, i.e. an epidural is unnecessary.
In general, there is not much to worry about spinal anaesthesia. However, if you are concerned, talk to your provider to ease your anxiety.